1. Field of the Invention
The present invention relates to operating room tables or surgical tables and, in particular, to operating room tables having an articulated or pivotal table top and appropriate controls for supporting a patient in a number of desired positions, most particularly, in a Trendelenberg""s position or in a reverse Trendelenberg""s position.
2. Description of the Background
Operating room tables which pivot or articulate to allow surgeons to place their patients in a particular position suitable for a particular surgical or other procedure are well known in the art. Hall (U.S. Pat. No. 4,865,303) describes one such table having a number of pivot points and pivot actuators which allow the table to pivot from end to end about a vertical plane (see FIGS. 13 and 14). Many other tables, having similar features, are well known in the art.
Over the years, physicians have found such tables to be useful when it is necessary to conduct surgical procedures which require the positioning of a patient in either a Trendelenberg""s position or a reverse Trendelenberg""s position. The Trendelenberg""s position is generally employed in laparoscopic procedures in the pelvic region. In this position, the patient""s pelvis is elevated above the patient""s head so that the intestines are drawn away from the pelvis toward the upper abdomen, thereby simplifying these laparoscopic procedures. In a reverse Trendelenberg""s position, the head is elevated above the abdomen allowing the intestines to fall toward the pelvis making it easier to conduct laparoscopic procedures in the upper abdomen. Common laparoscopic procedures conducted when the patient in is in a Trendelenberg""s position include procedures in the pelvic region involving the uterus, the ovaries, and other pelvic organs. Laparoscopic procedures directed to the upper abdomen which are generally conducted in the reverse Trendelenberg""s position include procedures relating to the gall bladder, hiatal hernias, liver biopsies, lymph node sampling around the stomach and the upper aorta, and the like.
Laparoscopic surgical techniques employing these surgical positions were advanced during the late 1970s. When patients undergo procedures in the Trendelenberg""s position, they are generally provided with a shoulder brace of one kind or another to support them and prevent them from sliding off the table. The length of these procedures, as with most surgical procedures, is believed to influence the associated quantity and type of morbidity. Lengthy procedures where the patient is in a 20-40% Trendelenberg""s position in shoulder braces, may provide unequal shoulder support or permit abduction of the arm to about 90xc2x0 or more, and may also predispose patients to a variety of neurologic sequelae. One of the most common causes of post-operative upper extremity neuropathy is compression and/or stretching of the brachial plexus which can result from such a procedure (see, for example Romanowski, L. et al., Brachial Plexus Neuropathies After Advanced Laparoscopic Surgery, Fertility and Sterility, 1993, 60:729-732; Westin, B, Prevention of Upper-Limb Nerve Injuries in Trendelenberg""s position Acta Chire Scand, 1959, 108,61-67; Wright, I. S., The Neurovascular Syndrome Produced by Hyper abduction of the Arms, A. M. Heart J. 1949, 29: 1-19; and Costly, D. O., Peripheral Nerve Injury, INT. Anesthesiol. Clin., 1972, Ken: 189-206.) It is believed that neuropathic injury, specifically brachial plexus injury, may persist as a relatively common operative complication unless the current generation of gynecological surgeons and other health care providers are familiar with both the etiology risk factors and preventive measures for brachial plexus stretch and/or injuries. A significant risk factor associated with laparoscopic gynecological procedures conducted when the patient is in the Trendelenberg""s position, as commonly practiced, is using pivotal surgical tables equipped with shoulder braces, harnesses or other devices designed to support or xe2x80x9ccatchxe2x80x9d the patient""s shoulders in order to prevent the patient from sliding off the table.
It will be appreciated, therefore, that improvements over the presently available surgical or operating room tables, which could minimize the frequency of brachial plexus neuropathies and other neuropathies associated with laparoscopic gynecological procedures conducted in the Trendelenberg""s position, would be a welcomed contribution to medical practice, and that prior art operating room or surgical tables present problems which are in need of solution. The present invention provides solutions for these and other problems.
The present invention is directed to a pivotal operating room table having a main patient support section having a main surface which lies in a first plane, and an elongated support member adjustably interconnectable to the main patient support section. The main patient support section is pivotally interconnected with a table support system such that the main surface can pass through a second generally vertical plane as the main patient support section pivots with respect to the table support system. The elongated support member includes an elongated support block, the support block having an upper surface area which includes a secondary support surface lying generally in a third plane. The third plane is generally perpendicular to the second plane when the elongated support member is interconnected with the main patient support section. The elongated support member is preferably adjustably interconnectable with the main patient support section at any of a number, preferably a myriad of heights above the main surface. In preferred embodiments the elongated support member includes an inflatable bladder resting above the secondary support surface. In further embodiments the operating room table will include a pair of elongated, parallel side rails on opposite sides of the main surface and interconnected with the main patient support section and generally parallel to the main surface. The elongated support member is adjustably interconnectable with each of the side rails. In alternate embodiments, the third plane may be oriented at an angle to the first plane, however, in certain embodiments, the third plane will be generally parallel with the first plane. As will be appreciated, in alternate embodiments the support block can pivot so that the third plane will pivot with respect to the first plane.
In other embodiments, the present invention provides an elongated support attachment for attachment to a pivotal operating room table. The preferred support attachment includes an elongated support member interconnected to a pivotal operating room table at a number of heights above a main surface of the table. The elongated support member preferably has a relatively hard underlying support surface and a relatively soft compressible overlying support covering above the underlying support surface. The overlying support covering preferably includes relatively soft support materials such that the overlying support covering can be compressed when bearing weight. The support materials preferably include an expandable bladder which can be inflated and deflated so as to contain varying amounts of air and to provide varying amounts of compressible cushioning capacity.
The present invention also provides methods of supporting a patient on a pivotal operating room table during a surgical procedure. In one embodiment, the method includes providing a pivotal operating room table having a main surface and an elongated support member adjustably interconnected therewith which provides a secondary support surface which can be adjustably secured at any of a number of heights above the main surface. This embodiment preferably includes the steps of (1) positioning the patient supine on both the pivotal main surface and the secondary support surface such that the secondary support surface is in contact with the lower lumbar region of the patient""s back; and (2) orienting the pivotal main surface such that the patient""s buttocks are elevated above the patient""s head in a Trendelenberg""s position; wherein the secondary support surface is positioned immediately below the lower lumbar region of the patient""s back and/or the upper portion of the patient""s buttocks so as to resist gravitational forces pulling the patient in a generally downward direction. In preferred embodiments, the step of positioning includes inflating an inflatable bladder resting on the secondary support surface to permit the elongated surface to conform in part to the shape of the patient""s back proximate the secondary support surface.
In a further embodiment, the method includes positioning the patient supine on both the pivotal main surface and the elongated support surface such that the elongated support surface is in contact with a lower portion of the patient""s buttocks; and orienting the pivotal main surface such that the patient""s head is elevated above the patient""s buttocks in a reverse Trendelenberg""s position; wherein the elongated support surface is positioned immediately below the patient""s buttocks and the lower portion of the patient""s buttocks rests at least partially against at least one of the edges of the elongated surface to resist gravitational forces pulling the patient in a generally downward direction. In preferred embodiments, the step of positioning includes inflating the bladder to permit the elongated support member to conform in part to the shape of the patient""s back proximate the lower portion of the patient""s buttocks where the elongated support member comes into contact therewith.
It is an object of the present invention to provide a pivotal operating room table which will permit the physician to conduct a laparoscopic surgical procedure when the patient is in preferably either a Trendelenberg""s position or a reverse Trendelenberg""s position, while minimizing the chance of causing brachial plexus injuries due to brachial plexus stretching and/or compression.
These and various other advantages of novelty that characterize the present invention are pointed out with particularity in the claims which are appended hereto and form a further part hereof. For better understanding of the present invention, however, its advantages and other objectives attained by its use, reference should be made to the drawings, which form a further part hereof, and to the accompanying descriptive matter, in which there is illustrated and described preferred embodiments of the present invention.